• Loss of deep tendon reflexes in lower limbs
• Loss of joint positions sense and vibration (doral columns) and stamping gait. (tabetic gait)
• Urinary retention

1. Promyelocytic variant - there is thrombocytopenia and DIC -> leading to a bleeding tendency. -> This variant is a medical emergency; high rate of early mortality. Complications: pulmonary or cerebral haemorrhage.
2. Some variant causing Gingival hyperplasia - monocytic subtypes M4 and M5
   1. 

[!TIP] Mnemonic: Seeing gum hyperplasia should make you PANiC
Panic if you see gum hyperplasia

• Phenytoin
• AML <- "rapidly forming gingival hyperplasia is usually the first sign of this disease" Source
• Nifedipine
• Ciclosporin

Treatment of AML

Current standard chemotherapy regimens cure only a minority of patients with AML.
Source
Most young patients should be considered for allogenic stem cell transplantation.

Note: Dead space is NOT a cause for hypoxaemia
: DH-DLS

| purpura - | purpura + (with normal PLT count) | purpura - | purpura of lower extremities |

Cardiac biomarkers

[!INFO] Types of biomarkers

Don't confuse the different types of biomarkers used in MI.

[!INFO] Key points for exams:

• myoglobin is the first to rise
• CK-MB is useful to look for reinfarction as it returns to normal after 2-3 days (troponin T remains elevated for up to 10 days)
• 
• Troponin levels rise within two to three hours of the onset of chest pain Source

The skeletal and cardiac isoforms of TnT (troponin T) and TnI (troponin I) are distinct. <- that's what's measured in MI.

cTnT = "cardiac troponin T"
skTnI = "skeletal troponin I"

Data suggest that brief periods of ischemia, sudden increases in preload, and physiological challenges like tachycardia and catecholamines can lead to the release of cTn.
4. Pulmonary embolism / pulmonary disease <- caused by right heart strain

Creatine kinase

• CK-MM, found in your skeletal muscle and heart.
• CK-MB, found in the heart and rises when heart muscle is damaged.
• CK-BB, found mostly in your brain. It's also found in smooth muscles such as the intestine or uterus.

• Palpable purpura (non thrombocytopaenic purpura) -> no thrombocytopaenia.

Alpha-1 antitrypsin deficiency

• Is a protease inhibitor which protects tissues against the action of enzymes like neutrophil elastase.
• Deficiency causes emphysema.
• INheritance: #autosomal-Recessive
• Genetic variants:
  • PiMM = normal individual
  • PiMZ = heterozygous; risk of emphysema developing if patient is a smoker.
  • PiSS = 50% of normal antitrypsin levels;
  • PiZZ = 10% of antitrypsin levels; affected and develops emphysema

Management: intravenous alpha1-antitrypsin protein concentrates + smoking cessation, supportive bronchodilators etc .

Source <- Dynamic air trapping in COPD.